First Endocrinologist Appointment: My Brain is Broken

First Endocrinologist Appointment: My Brain is Broken

When I got my initial referral, and found out I was looking at a 3 month wait time, I was… perturbed.

Then I remembered that my girlfriend is the most well connected Melbournian in the world. She asked a few people who asked a few people and hey presto, someone had a cancellation and they were available in 2 days.

Boom.

Hypogonadotropic hypogonadism.

What does that mean? Hypogonadism means ones testes aren’t producing. And Hypogonadotropic hypogonadism is a form of hypogonadism caused by a pituitary or hypothalmic deficiency.

FSH and LH

Brain.

Maybe we should take a step back…

There are a few steps involved here.

The hypothalamus prompts the pituitary gland, a pea-sized thing in your head, to produce Leutenising Hormone (LH) and Follicle Stimulating Hormone (FSH).

LH stimulates testosterone production in the testes. FSH stimulates sperm production.

My LH is <1, where the normal range is 2-8 IU/L. Which is low. My FSH is 2 IU/L, where 1-8 is the normal range. So FSH is normal, LH is low. Apparently one would expect FSH to be very high if LH was low, but mine is not. Medical mystery #1.

My serum testosterone is 1.4 nmol/L (normal range 6-28), and my free testosterone is 42 pmol/L (normal range 200-600).

This is not good.

Dr. Nolan

Prolactin

Finally, there’s prolactin. This is the hormone that triggers the production of breast milk. All men have it. The normal range is 45-375mIU/L – mine is 127. Normal! Hooray!

Except that one reason for the low testosterone would also create high prolactin… so this only confuses things.

Prime Candidate

At the moment the most likely offender is a pituitary tumor. Except my FSH is normal, as is my prolactin. So while it is the most likely offender, it’s not actually that likely.

Next Steps

The next step is an MRI to see if there’s anything obvious growing in my noggin that really shouldn’t be.

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